Individual clearance and therapeutic drug monitoring of quetiapine in clinical practice.

OBJECTIVE: Quetiapine is one of the most frequent prescribed antipsychotics. Based on the consensus guidelines of therapeutic drug monitoring (TDM) in clinical practice, TDM of Quetiapine is "useful". In this pilot study, using a natural sample, we investigated the influence of co-medication, age and gender on the serum concentrations and clearance of Quetiapine. Also we compared the individual clearance in our sample with the expected clearance for healthy subjects, obtained in controlled studies. METHODS: 150 blood samples were collected anonymously under clinical conditions, Quetiapine trough serum levels were determined using HPLC. Additional information about gender, age, co-medication and dosage was obtained. RESULTS: There was a significant, positive, but weak correlation between daily dose and serum levels of Quetiapine (r=0.44; p=0.01). When Carbamazepine was co-administered, the clearance was significantly higher (p=0.01). 83% of the serum levels were outside the therapeutic range, only 28% were within the expected clearance. CONCLUSIONS: In addition to the therapeutic range the individual clearance related to the expected clearance may help to optimize individual pharmacotherapy, especially for combination therapy or in case of incompliance or abnormal metabolism.

SARS-CoV-2 Risk Management in Clinical Psychiatry: A Few Considerations on How to Deal With an Unrivaled Threat.

The pandemic spread of the corona virus SARS-CoV-2 has even-handedly shattered national and international health systems and economies almost in an instant. As numbers of infections and COVID-19-related deaths rise from day to day, fears and uncertainties on how to deal with this unknown threat are extremely present both for individuals and societies as a whole. In this manuscript, we aim to exemplarily describe the bullet points concerning (a) the internal risk management, (b) the organizational and structural changes, and (c) the communicational strategies applied in a Psychiatric University Hospital in the Southern part of Germany. The authors are well aware about the fact that almost none of these considerations may be considered as evidence-based at the moment. However, the authors trust that these reflections and experiences may be useful as an orientation for similar risk constellations in other afflicted countries due to the temporal delay of the pandemic course.

Gender differences in help-seeking behavior on two internet forums for individuals with self-reported depression.

BACKGROUND: The published literature reflects differences between the sexes in the help-seeking behavior of individuals with depression. Professional mental health services reach men to a lesser extent than women. Internet forums are considered an option to better reach males specifically. OBJECTIVE: We investigated gender differences in the active use of the Internet to access English- and German-language information on depression. METHODS: Analysis differentiated contributors' sex for 200 threads (clusters of responses related to one person seeking advice) followed on 2 Internet forums, www.defeatdepression.org, originating from the United Kingdom, and www.verrueckt.de, originating from Germany. From the qualifying date of January 3, 2007, the investigated threads retrospectively reached 149 days. Using 2 variables, "sex ratio of regular Internet users" and "epidemiologically expected sex ratio," we calculated a hypothetical value for the female-to-male (F:M) ratio of requests for help of 1.23 for the United Kingdom and 1.16 for Germany. Then we compared the actual versus the estimated gender distributions with a 2-sided chi 2 test. RESULTS: We included 89 queries from www.defeatdepression.org and 97 queries from www.verrueckt.de. On the English-language forum, 46 (52%) of the queries were from women and 43 (48%) from men. On the German-language forum, 67 (69%) of the queries were from women and 30 (31%) from men. The German forum had a significantly higher F:M ratio of contributors compared with the English forum (2.23 vs 1.07, respectively; chi 2 = 5.885; P = 0.015). The actual F:M ratio of contributors for the English forum was similar to the expected calculation (1.07 actual vs 1.23 expected; chi 2 = 0.230; P = 0.652), but was significantly lower than the actual versus the expected F:M ratio of contributors for the German forum (2.23 actual vs 1.16 expected; chi 2 = 4.891; P = 0.027). CONCLUSION: Possible reasons for the German Internet forum having a higher F:M ratio of contributors compared with the English Internet forum are the differences in presentation style, language, and cultural context between the 2 Web sites.

Acute psychiatric inpatient care: a cross-cultural comparison between two hospitals in Germany and Japan.

BACKGROUND: Intercultural differences influence acute inpatient psychiatric care systems. AIMS: To evaluate characteristics of acute inpatient care in a German and a Japanese hospital. METHOD: Based on a sample of 465 admissions to the Psychiatric State Hospital Regensburg (BKR) and 91 admissions to the Hirakawa Hospital (HH) over a six-month period in 2008, data from the psychiatric basic documentation system (BADO) were analysed with regard to socio-demographic characteristics, treatment processes and outcome indicators. RESULTS: Schizophrenia and related psychosis was the most common diagnosis in both hospitals. Cases at the BKR were admitted more quickly after onset of the present episode. Global Assessment of Psychosocial Functioning (GAF) ratings at admission were lower at the HH. Most admissions to both hospitals received psychopharmacological treatment, but more at the HH received psychotherapy. Length of stay was significantly longer at the HH (75 days) than at the BKR (28 days). Admissions to the HH were more improved with regard to GAF and clinical global impression (CGI). CONCLUSIONS: Acute admissions in Germany provide intensive care with short hospitalization as crisis intervention. For acute admissions in Japan, comprehensive care for severe mental illness precedes emergency admissions and achieves greater improvement with longer hospitalization.

Recognizing and treating peripartum depression.

BACKGROUND: In this article, we review current data on the prevalence of, risk factors for, and treatment of peripartum depression. METHOD: Pertinent publications were retrieved by searches in Medline and the Cochrane Library using the key words "peri/pre/post", "partum/partal/natal", "maternal/motherhood/pregnancy", and "depression/affective disorder". RESULTS: Depression is the most common peripartal disease: The prevalence of depressive disorders is 18.4% during pregnancy and 19.2% in the puerperium. Prepartum depression is associated with preterm birth, low birth weight, and an abnormal fetal heart rate. In the long run, children of depressed mothers have been found to have impaired cognitive and emotional abilities. Risk factors for peripartal depression include prior depression, poor social support, poor quality of intimate relationship, and negative live events. Peripartum depression can be treated effectively with psychotherapy or drug therapy. Current data support the use of antidepressants during pregnancy and breastfeeding. In many places, pregnancy counseling centers offer low-threshold psychosocial assistance. Nonetheless, no more than 20% of the affected women are identified, even though rapid screening would be possible with instruments such as the Edinburgh Postnatal Depression Scale (EPDS) and the two Whooley questions. CONCLUSION: Peripartum depression is both common and treatable. Screening for depression should become a routine part of both prepartum care by gynecologists and postpartum care by midwives. This will only be possible, however, with expanded availability of ambulatory and inpatient psychotherapy and psychiatric care for the affected women and their children.

Revisiting the association of aggression and suicidal behavior in schizophrenic inpatients.

Our study investigated the association of aggression and suicidal behavior in schizophrenic inpatients. Eight thousand nine hundred one admissions for schizophrenia (1998-2007) to a psychiatric university hospital were included. Schizophrenic suicides (n = 7)/suicide attempters (n = 40) were compared to suicides (n = 30)/suicide attempters (n = 186) with other diagnoses and to schizophrenic non-attempters regarding aggression. Logistic regression analysis was performed to explore risk factors for attempted suicide. Schizophrenic suicides/suicide attempters did not differ from other suicides/suicide attempters or from schizophrenic non-attempters with regard to aggression. Risk of inpatient suicide attempt was increased for patients with attempted suicide at admission, high school graduation, and disorganized subtype. Aggression could not be found to be a predictor of attempted suicide. Aggression seems to have a minor role for suicidal behavior in schizophrenia.

[Small numbers, big results: Weiden--a suicide stronghold?]. / Kleine Zahlen, große Ergebnisse: "Suizidhochburg" Weiden?

OBJECTIVE: According to a recent survey based on the years 2005-2007, the highest suicide rate in Germany was found for the town Weiden (Bavaria, Upper Palatinate). We aimed at having a closer look at this finding by using a longer investigation period (2000-2008). METHODS: Suicide rates of Weiden were contrasted with suicide rates of Bavaria and Germany. Data were obtained from the Bavarian State Office for Statistics and Data Processing and the German Federal Statistical Office. RESULTS: The finding named above was based on the influence of a data outlier (2006) in the number of annual suicides which is clearly evened out by examining the longer investigation period from 2000-2008. The suicide rate of Weiden is indeed higher than suicide rate of Germany and slightly higher than suicide rate of Bavaria, but not to such a drastic degree as had been stated. CONCLUSIONS: Investigation period and number of inhabitants have to be considered at interpreting suicide rate studies to prevent jumping to a conclusion.

[Antipsychotic treatment of dementia after publication of new risks]. / Folgen neu erkannter Arzneimittelrisiken auf die Antipsychotikaverordnung bei Demenzerkrankten.

OBJECTIVE: We investigated the change of antipsychotic treatment of elderly persons with dementia after several publications indicated an association between use of antipsychotics and cerebrovascular events in this population. METHODS: Twice a year, the complete medication, age, diagnosis and gender of all inpatients in 30 German psychiatric sites is collected anonymously in a data base for statistical analysis. RESULTS: The treatment changed for the benefit of Quetiapine and Haloperidol. The use of both Risperidone and Olanzapine decreased markedly. CONCLUSION: The antipsychotic treatment changed due to critical publication. But, the evidence for the risk profile is still a matter of debate.

[Risk profiles for suicide of schizophrenic and depressive inpatients - a psychological autopsy study]. / Risikoprofile für den Kliniksuizid schizophrener und depressiver Patienten - eine psychologische Autopsiestudie.

OBJECTIVE: This psychological autopsy study investigates suicide risk factors of schizophrenic and depressive inpatients. METHODS: 67 potential risk factors of inpatient suicide were identified by means of literature research and caregiver interviews of schizophrenic and depressive suicidents (1995-2004). The medical records of the suicidents (n = 20) were analysed in respect to the identified risk factors and compared to their respective control group of non-suicidents (n = 20) which was matched by diagnosis, gender, age, year / month of admission and ward. Univariate and multivariate statistical analyses were performed. RESULTS: In comparison to their respective control group schizophrenic (n = 11) and depressive suicidents (n = 9) differed clearly by their risk profile. Suffering from side effects of medication was found to be a predictor of suicide for schizophrenic inpatients. CONCLUSIONS: Psychological autopsy studies are indispensable for the construction of diagnosis-specific risk profiles. Reduction of side effects of medication seems to play a larger role in suicide prevention for schizophrenic inpatients than previously assumed.

[Information and consent in psychiatry and psychotherapy]. / Aufklärung und Einwilligung in Psychiatrie und Psychotherapie.

OBJECTIVE: The number of medical liability court cases in Germany has more than trebled over the past 30 years. In almost every case of a therapeutic failure, the accusation is one of insufficient medical information. It was investigated which requirements information for patients has to meet in the field of psychiatry and psychotherapy. METHODS: The supreme court jurisdiction relating to patient information and consent in medicine was analysed. Legal and medical documents on the topic were also evaluated. RESULTS: Doctors' legal duty to provide information includes the areas of therapeutic information, enabling information for the patient, and information relating to costs. The burden of proof is always on the doctor, and the documentation needs to be legally safe. CONCLUSIONS: The legal basis relating to patient information and consent is consistent with the objectives of patient oriented psychiatry and psychotherapy. However, many legal requirements are exaggerated and far removed from medical practice. The specialist societies are called on to develop guidelines on how to provide information during the medical consultation.

[Psychopharmacoepidemiology: differences in prescribing strategies in the inpatient and outpatient settings]. / Psychopharmakoepidemiologie: Qualitative Unterschiede zwischen stationären und ambulanten Verordnungsstrategien.

OBJECTIVE: Doctors' prescribing behaviour in 34 psychiatric hospitals in southern Germany was investigated and compared with outpatient prescribing behaviour of doctors licensed to practise within the German health insurance system. METHODS: On the basis of the AGATE cut-off dates for 2000-2006, we analysed developments in the drug groups antidepressants, neuroleptics, benzodiazepines, and antidementia drugs over time. RESULTS: The proportion of inpatient prescriptions of antidepressants and antidementia drugs is increasing, whereas neuroleptics and benzodiazepines are undergoing the reverse trend. The proportion of generics in inpatient prescriptions is notably lower than in outpatient prescriptions. CONCLUSIONS: The differences between inpatient and outpatient prescribing behaviour results in a lack of continuity of care. Health economic incentive systems therefore require standardisation.

[Does sociotherapy lose importance in scientific discourse?]. / Verliert die Soziotherapie im wissenschaftlichen Diskurs an Bedeutung?

BACKGROUND: Sociotherapy is an approved method in the treatment of mental disorders. The present study aimed at evaluating the role of sociotherapy in a scientific journal during the last 20 years. METHODS: A systematic analysis of all papers published in the "Psychiatrische Praxis" in the years 1985/1986, 1995/1996 and 2005/2006 was carried out. RESULTS: During the last two decades the proportion of papers with sociotherapeutic topics has decreased significantly. 20 years ago one out of four articles dealt with sociotherapy, currently only one out of ten. In addition, the spectrum of themes is diminished, only the topics work rehabilitation and relatives are represented in the latest issues of the journal. CONCLUSION: In contrast to its clinical value, sociotherapy has lost importance in psychiatric research. Multidisciplinary collaboration is required to enhance sociotherapy in mental health care research.